Levemir
Levemir is Novo Nordisk A/S's worldwide brand name for insulin detemir, a long-lasting insulin analog that lasts up to 24 hours in humans. Its chief benefits according to Novo are a "peakless" action, less weight gain than other insulins, and much less day-to-day variability than NPH or Lantus insulins. Levemir was approved for use in Europe in 2003, and by the US FDA in June 2005. It is expected to be available commercially in the USA by the end of 2005.http://www.levemir-us.com/ For vets and prospective new users, please see these few Cases of cats and dogs using Levemir. Technical details Levemir is a clear solution created by genetically engineered yeast. It is analogous to human insulin, but includes a "fatty acyl side chain" that binds temporarily to albumin (found under the skin and in abundance in blood plasma) and makes the molecule "cling" to the bigger albumin molecules for a while before releasing -- this gives the slowed action. Unlike its long-acting rival Lantus, Levemir's time-delay action occurs in the bloodstream, not only at the subcutaneous injection site, and doesn't depend as much on the properties of the injection site or the diluent (which is Isophane, like NPH insulins). Practically, this means that Levemir is much less sensitive to dilution, mixing, than Lantus (though mixing and dilution are still not recommended, there's a chance they may be allowed later.) Injection sites should be rotated to avoid granuloma, as in most insulins. Injecting ANY insulin at the same site can cause a lipodistrophy of either lipoatrophy or lipohypertrophy. Either makes absorption unreliable. But varying the injection site can cause variability in action profile, too. This page illustrates the most common areas humans with diabetes inject insulin and explains how absorption differs in different areas of the human body. This is true for ALL insulins. Levemir's stretched-out action in the bloodstream makes it less dependent on injection site conditions than Lantus. This claim from Novo Nordisk is boosted by its findings of lower day-to-day variability on Levemir compared to Lantus. Levemir's action profile, according to Novo's Trial NN304-1338, a randomised, double-blind, cross-over trial involving 12 subjects, looks like this: Veterinary use It's too early to say if Levemir is a good insulin for cats or dogs, but it seems effective in early feline cases. Here's a full 24h glucose curve in the first known feline case, Jocularity. Notice that Jock's dose (3.25U for 6.5kg) here is higher than those shown in the Novo experiments (0.5 U/kg), and that his peak is close to 11 hours. This is consistent with the shifting peak time shown in the 0.2, 0.3, and 0.4U/kg cases above. But it's consistent with human times, not the usually sped-up feline times. Possible explanation: The protein-binding time-delay action of Levemir is not dependent on the animal's metabolism, or at least not the same part of it that makes other insulins run faster in cats. Notice that except for the rise at the beginning (likely due to slow onset), the curve is nearly symmetrical, gradual on both sides, and lasts 21 hours before returning to previous level. This means it's very easy on the animal both at the beginning and end of its action, and it can easily be overlapped to the next dose without surprises or difficult calculations. Usage and Handling Levemir comes in pen cartridges or prefilled insulin pens only, not in vials at this time. It is compatible with all Novo Nordisk insulin pens including the Novopen Junior and Novopen 3 Demi, which both allow half-unit doses. Dosages finer than 1/2 unit increments must be dispensed by using a syringe with the cartridge, which is in this case quite easy. Inject an equal volume of air into the cartridge before drawing insulin, to keep pressure equalized. Also, do not reinsert a cartridge into a pen after using it with a syringe, to avoid stress on the pen mechanism and likely destruction of the cartridge or pen. Levemir's shelf life is 2 years. After first opening the product must be stored for a maximum of 6 weeks, not above 30°C. It may be stored in a refrigerator (2°C - 8°C) not near a freezing compartment. Do not freeze. Protect from light. Source: EMC The insulin is clear and does not appear to need rolling or agitation. During use it should not be refrigerated, but stored in a dark cool place below 30°C. Levemir appears to work fine when stored overnight in syringes for prepared dosing. Novo Nordisk themselves have not yet tested diluted Levemir, and so have no consistent answer about whether this is possible. About mixing with other insulins they say: "If Levemir is mixed with other insulin preparations the profile of action of one or both individual components may change. Mixing Levemir with a rapid-acting insulin analogue like insulin aspart will reduce and delay the maximum effect of the rapid-acting insulin compared to that observed following separate injections." External Links *Medical summary sheet *Cases of cats and dogs using Levemir *Less variability (Novo Nordisk) plus this Powerpoint presentation *Improved Glycemic control (Novo Nordisk) *Less weight gain (Novo Nordisk) *Launch information for the US *Cool video of insulin action! Category:InsulinsCategory:AnalogsCategory:long-actingCategory:Novo NordiskCategory:R-DNA/GE/GM